Individual
MARY REISIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
2255 CLINTON AVE S, ROCHESTER, NY 14618-2623
(585) 473-6301
(585) 473-6911
Mailing address
601 ELMWOOD AVE, BOX 668, ROCHESTER, NY 14642-0001
(585) 473-6301
(585) 473-6911
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
420578
NY
363LW0102X
Women's Health Nurse Practitioner
F420578
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02414868
—
NY
01
—
P00031020
MEDICARE RR
NY
Enumeration date
06/15/2006
Last updated
06/29/2023
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